The number one cause of heel pain is plantar fasciitis. It develops more so in all types of active and athletic individuals. Runners account for as much as 10 percent of all running injuries and are the ones who are most susceptible to plantar fasciitis (PF). However, PF symptoms may also arise just by standing or walking on a hard surface. In treating PF which is sometimes difficult, the acupuncturist needs to always have a positive expectation of the success of the treatment. With the inclusion of other alternative therapies and precise needling of acupoints, the success rate of the treatment can be quite high.
An irritation and inflammation of the plantar fascia which is the tissue that connects your foot’s front to your heel, plantar fasciitis can be the result of a micro-tearing occurring in the fascia’s near attachment to the calcaneus or in the fascia itself. Half of PF patients are known to develop a calcaneal heel spur. In women with PF, about 90% are overweight, while in men with PF, 40% are overweight. While PF usually occurs from a repetitive stress injury (overuse), it can also arise due to acute trauma caused by intense activities of the lower extremities.
The heel’s plantar aspect is where the pain’s usually felt. This is accompanied by stiffness. These symptoms can travel along the arch near the area of the acupoint Ki 1 (Yongchuan) and can even be felt as far as the toes. Symptoms can be experienced in the morning when taking first steps or after prolonged rest or sitting or upon standing. With moderate activity that helps stretch the fascia or as the patient “warms up,” the symptoms can be allayed a bit. During the early stages of a run, runners with PF often experience no pain; however, the pain usually returns after a workout or towards the end of a workout. Likewise, symptoms commonly worsen at the end of the day and are usually dormant during the day.
Plantar fasciitis is the most common diagnosis when it comes to pain felt in the heels more so if the pain follows aggravation patterns described above. Still, there are can be a number of possible reasons for heel pain that can mimic the symptoms presented by plantar fasciitis and which the acupuncturist should not overlook. These conditions can include periosteal bruising, Achilles bursitis, or Achilles tendonitis.
With regards to periosteal bruising, rather than the Shimian M-LE-5 sensitive point in the fascial attachment’s area, the pain can be felt across the surface of the plantar region. In Achilles bursitis, directly at the calcaneal attachment, pain can be felt that affects the Achilles bursae when the plantar region is pinched in a pinch test.
With Achilles tendonitis, when compared to the unaffected side, the tendon affected by PF shows inflammation and thickening. Pain is felt when the proximal tendon attached to the plantar fascia is pinched in a pinch test. Both Achilles bursitis and tendonitis can refer to pain to the heel.
One should also be aware that a condition known as “fat pad syndrome” can be caused by a heel bruising due to a thinning fat pad that has been exposed to repetitive stress. The elderly and women are the ones most susceptible to this condition. Plantar pain can occasionally be referred from the soleus muscle, which is a type of ailment called “jogger’s heel.”
Not all PF patients complain of predictable heel pain patterns which get worse after prolonged sitting or when taking the first steps in the morning. The above-mentioned periosteal bruising can present in this fashion. Moreover, the acupuncturist needs to also take into account the possibility of medial plantar nerve entrapment. Although the patterns differ, the pain it generates can mimic that of plantar fasciitis. In medial nerve entrapment, the patient may usually find relief in the morning; as the day moves on, the pain progresses especially when the patient stands, walks or do other activities.
In examining a patient with PF, the acupuncturist should begin with palpation of the center of the heel’s plantar surface, which is the Shimian M-LE-5 extraordinary point. The calcaneous’s medial tubercle should also be palpated because pain is often felt on the heel’s medial surface. Plantar fasciitis can be suggested when with modest pressure from the thumb or finger pain is felt although the practitioner should compare the sensitivity with the unaffected side. In evaluating the affected heel’s plantar surface, the practitioner might possibly also feel a heel spur.
A change in training such as increased speed, hills, or mileage can be usually associated with plantar fasciitis. Other contributors to the condition can include a change in running surface or running shoes. The practitioner can recommend to the patient having his/her foot evaluated for any biomechanical imbalances like what most patients with lower-extremity injuries need to undergo. Research shows that more than 80% of these injuries are the result of foot pronation stretched beyond normal limits. Low or high arches, discrepancy in leg length, decreased fat pad thickness and other anatomical issues can also increase the risk of plantar fasciitis development.
Acupuncture Treatment – An overview
Under the category of trauma/ accident plantar fasciitis is usually diagnosed. This condition often comes from a repetitive stress disorder brought about by a gradual or sudden increase of micro-trauma. Occasionally though, PF may develop as an acute strain. At the bone, ligament, and tendon levels, inflammation can be seen. In the collateral and channels, there is stagnation of blood and qi. Possible contributing factors include imbalances in the internal organs.
Treatment for three weeks two times a week is recommended. After that, the condition is reassessed. Typically within six treatments, barring any complications, improvements can be seen. For chronic types of PF, treatment should be continued after the first three-week period, at least, once each week,
Emily Farish Acupuncture
400 S. Jefferson, Suite 203
Spokane, WA 99204